Provider Demographics
NPI:1174906085
Name:RITTER, MIRANDA LEA (MS, CCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:LEA
Last Name:RITTER
Suffix:
Gender:F
Credentials:MS, CCC,SLP
Other - Prefix:MISS
Other - First Name:MIRANDA
Other - Middle Name:LEA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1601 GREENHOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-9292
Mailing Address - Country:US
Mailing Address - Phone:479-795-1260
Mailing Address - Fax:479-795-1261
Practice Address - Street 1:1601 GREENHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-9292
Practice Address - Country:US
Practice Address - Phone:479-795-1260
Practice Address - Fax:479-795-1261
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist